A poignant, honest blog about my life, childbirth, and other topics that affect women.

Friday, October 8, 2010

Postpartum PTSD: Birth Trauma in the U.S.

The most troubling aspect of the current state of affairs surrounding birth in the U.S. is one that hits very close to home: postpartum post-traumatic stress disorder (PTSD). This disorder is very personal because I still suffer from PTSD as a result of my first child’s birth more than four years ago. There has been an increase of interest in the disorder from the media as more and more women are starting to come out of the woodwork and describe their birth experiences as extreme trauma or even “rape”. These descriptions might raise eyebrows when people naturally expect women to endure childbirth in order to get a healthy baby. The image of a woman screaming in terror as the heroic doctor delivers the baby is an all-to-common scene in movies and TV shows. But is birth supposed to be traumatizing? Does the birth experience really matter or are women who describe being birth-raped overreacting?

Most people are familiar with postpartum depression, and that is not surprising considering the troubling statistics that one in ten women will be diagnosed with this debilitating disorder. However, the diagnosis of postpartum PTSD is a relatively new one. PTSD is usually associated with soldiers returning from war or survivors of rape or natural disasters. Symptoms of PTSD include recurrent distressing memories of the event, nightmares, flashbacks, panic and anxiety. People who suffer from PTSD usually go out of their way to avoid places or objects that remind them of the traumatic event, such as driving on the other side of town to avoid the hospital where the traumatic birth took place.

A recent U.S. survey showed that, of more than 900 mothers, 9% had a positive screening for postpartum PTSD. Also, 18% of the women surveyed had some symptoms of the disorder. Earlier studies which had been done outside of the U.S. had put the rates of postpartum PTSD somewhere in the range of 1.5% and 5.9%. These studies would suggest that the rates of postpartum PTSD in the U.S. are disturbingly high. It has been suggested that the rise in these rates can be attributed to the increase in interventions in birth as well as cesarean sections and feelings of helplessness in threatening situations.

Many of the women who suffer from postpartum PTSD have horror stories for birth stories. They describe feeling betrayed by the same attendants that they trusted would provide them with the birth experience that they had planned for. These women had procedures done against their will or without their consent. They felt threatened or coerced by their attendants into having inductions, c-sections, or instrumental deliveries which were not medically indicated. They had fingers, hands, scissors, and scalpels in them after they had protested against such actions. A chilling example is the case of Catherine Skol whose horrific birth experience included her husband holding her down while her doctor repaired a laceration without anesthetic.

So are these women exaggerating their experiences? Are these women who feel violated, birth-raped, or whose care providers put them or their babies lives in jeopardy overreacting? Is birth trauma a relative term and a matter of how the birth is processed? As someone who has experienced these feelings, I would say absolutely not. Birth is a very raw, primal, intimate process. When the people you entrust to share in this process with you breech this trust, trauma occurs.

Postpartum PTSD changes your life and how you view your birth and baby forever. How can it be enough to have a healthy baby when the mother is in a state of trauma from the same experience which should have been the most empowering experience of her life? These mothers feel shattered and shaken. They have less confidence in their abilities as mothers because their birth experiences were stolen from them. It can affect their ability to breastfeed and bond with their baby as well as their relationships with their partners, family, and fiends.

Is it just a pie-in-the-sky fantasy to believe that birth can be beautiful and not traumatizing in the least? We are born trusting birth and accepting that it is normal. If you show a video to a

young child of a smiling woman giving birth their response will be something nonchalant like, “Oh! Cute baby!” Children don't expect birth to be traumatic, and neither should we. If over

90% of women can give birth safely without interventions, then we must not accept the current rise of inductions, cesareans, and other interventions in this country. If we want to raise a generation of healthy children, we must protect and empower their mothers. We have to stop accepting birth trauma as the norm and expect birth ecstasy instead. There is no excuse for the rising rates of postpartum mood disorders in this country. These rates are a disgrace and should make people outraged and demand a change.

So what can be done to avoid PTSD and other tragic postpartum disorders? It would seem that the common denominator among women who suffer from PTSD would describe feelings of helplessness during their birth experiences. People who provide care to birthing women need to understand that the birth belongs to the mother, not them and they must never take that power from the mother. Birthing women should have the final say in what happens to them in labor and postpartum. Women need to birth in ways that minimize interventions and surround themselves with positive people who trust birth and believe in their abilities. Women need to be re-taught to trust in birth and in their bodies and that to believe that birth is inherently dangerous is to believe a lie. Informed, empowered women who are supported in their choices have the safest and healthiest births, physically, emotionally, and mentally. They enter motherhood feeling on top of the world and ready to take on the challenges of raising a new life. I don't think that's too much to ask.

Great article! I think the biggest determining factor in whether or not the birth experience will be traumatic is the attitudes of the care providers (nurses, midwives, doctors, etc.). At my first birth, the care providers seemed to think I was standing in the way of my child's birth and very hands-on, violating tactics were used. I cried every time I told the story, for at least a year afterward. Before I'd even heard the term "hospital rape" I described it as like being raped.

My second birth was a home birth in our oval tub with a midwife sitting in the other room during the labor, only coming in to check on things and to help with shoulder dystocia (no C-section needed, thank you). I am 100% positive that with my old care providers, this second birth would have been just as traumatic for me and baby as the first.

Thank God for good midwives who know the power of women and the craft of natural birth that is all but lost from the States.